This proposal describes a three-year effort to implement and evaluate the results of the consolidated imaging initiative research - a shared, standards-based, interoperable health information technology dubbed CI-PACS (Consolidated Imaging - Picture Archiving and Communication System) among three hospitals in rural Maine. This is not a request to simply fund the implementation of PACS at the partner sites, but a rather request to collaboratively implement an innovative approach to share a PACS, resulting in significant cost savings and patient care improvements. This partnership was established under the leadership of MaineHealth, a nonprofit integrated healthcare delivery system that serves approximately three-quarters of the state's 1.2 million population. Since its inception in 1997, MaineHealth has undertaken a number of strategic initiatives to improve quality and access to care, while reducing costs. Among these is a regional plan for the development and deployment of an array of information technologies, of which CIPACS is a key element. [unreadable] [unreadable] The benefits of PACS to the quality and cost effectiveness of the care provided at Maine Medical Center MMC), the largest member of MaineHealth, have been tremendous. Many clinicians have commented that the implementation of PACS at MMC has been the single most important health information technology (HIT) advancement they have ever experienced. At MMC, images are now available for review both by radiologist and other clinicians within minutes of when they are acquired. The time to produce the final radiology report has dropped precipitously from the pre-PACS era, resulting in improvements in the care provided at MMC. [unreadable] [unreadable] We believe the partners we have assembled (a tertiary care hospital, a member community hospital, and non-member community hospital), coupled with the special characteristics of Maine, present an ideal setting in which to study the process and outcomes of implementing a consolidated approach to PACS - a technology that we believe is one of the fundamental building blocks of a regional, consolidated health information system. Each partner has a set of different, yet complementary goals for the project, under the broad headings of improving access and quality and reducing cost. Achieving these goals will result in the discovery of new knowledge about the process of implementing a consolidated PACS and important lessons that are relevant to other rural health networks. [unreadable] [unreadable]